Date of Award

Fall 10-2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

School

Communication

Committee Chair

Kathryn Anthony

Committee Chair School

Communication

Committee Member 2

John Meyer

Committee Member 2 School

Communication

Committee Member 3

Kyna Shelley

Committee Member 3 School

Education

Committee Member 4

L. Paul Strait

Committee Member 4 School

Communication

Committee Member 5

Steven Venette

Committee Member 5 School

Communication

Abstract

The deployment of navigators as liaisons between cancer patients and their Multi-Disciplinary Teams (MDT) affords a high level of coordinated care that is otherwise difficult to attain. Highly functioning navigators provide a multitude of support roles, the primary being the dissemination and interpretation of information to and from patients and providers in a manner that is digestible to all recipients. Navigators face hurdles in the form of communication breakdowns within the MDT which can negatively impact level of care and lead to patient uncertainty. Patients face additional barriers of their own which serve to further heighten uncertainty and cause patients to seek additional resources to support their decision-making process as they traverse the cancer care continuum. Interviews were conducted with ten (n = 10) multidisciplinary cancer care team members, as well as ten (n = 10) navigators to determine factors affecting the navigator's liaison function between the patient and multidisciplinary team (MDT). In depth interviews were also conducted with ten (n = 10) cancer patients to better understand how they manage uncertainty when making medical decisions in the absence of sufficient communication with the MDT and/or navigator. MDT members and navigators’ interviews revealed communication breakdowns within the MDT that fell into six thematic categories: opacity of the navigator role, MDT collaborative care deficiencies, incompatible modes of team communication, scarcity of time, perceived financial limitations of the navigator position, and suboptimal dissemination of patient health information. Each theme is underpinned by data offering insight into refinements that can be implemented to enhance the navigator’s boundary spanning function. Patient interviews offered insight into how they managed uncertainty and made medical decisions in the absence of sufficient communication with their MDT. The researcher aimed to determine avenues of resolution, but it became evident that the cause of the communication breakdown and the patients’ subsequent decision-making processes were intrinsically linked. Analysis revealed several thematic categories of compromised patient-provider communication and how the patients subsequently dealt with these limitations including: patient shock at the time of diagnosis, insufficient pre-treatment (health information) and post-treatment (inconsistent) communication, and patient exclusion from care planning. Findings from this research are multi-faceted and far reaching in scope with applications to coordination and quality of care, impact to health, patient satisfaction, and perhaps even hospital profitability. Analysis of the research data obtained from patient and MDT member interviews allowed for identification of barriers affecting communication between the MDT, navigator, and patient, and illuminated appropriate adjustments that could be implemented to improve communication and quality of care.

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